This is an important paper because it demonstrates the need to stratify the analysis of the results of shoulder arthroplasty. Post-traumatic arthritis is not the same as osteoarthritis! The authors provide a minimum of two years of followup on 55 patients with post-traumatic deformity, 44 of which had total shoulder arthroplasty and the remainder hemiarthroplasty. The worst results were in shoulders with cuff degeneration and those with proximal humeral deformity, especially varus malunion of the humerus as shown below
In such cases a standard stemmed humeral component cannot be properly replaced. While tuberosity osteotomy may be tempting, we agree with the authors that it is not a good idea because of problems with non-union and excessive tension on the repositioned cuff. Such situations can sometimes be addressed with resurfacing prostheses.
Even in these expert hands, the results for shoulders with post-traumatic arthritis are inferior to those for osteoarthritis (thus the case for analyzing these results separately). The authors emphasize the technical difficulty of these cases and the fact that each reconstruction must be highly individualized. Care in preoperative templating, subscapularis management, release of contractures, biceps tenodesis/tenotomy, avoiding greater tuberosity osteotomy, broaching, use of smaller stems, cementing (rather than press-fit fixation), and consideration of the status of the glenoid surface are all important elements of the procedure.
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Use the "Topics" box to the right to find other posts of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery.
See the countries from which our readers come on this post.
